Provider Demographics
NPI:1902308760
Name:WAUNAKEE OPERATIONS, LLC
Entity Type:Organization
Organization Name:WAUNAKEE OPERATIONS, LLC
Other - Org Name:WAUNAKEE MANOR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:Q
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-401-9960
Mailing Address - Street 1:801 S KLEIN DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1575
Mailing Address - Country:US
Mailing Address - Phone:608-849-5016
Mailing Address - Fax:608-850-4689
Practice Address - Street 1:801 S KLEIN DR
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1575
Practice Address - Country:US
Practice Address - Phone:608-849-5016
Practice Address - Fax:608-850-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2450251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care